Cervical Cancer Treatment Regimens

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SEE BELOW THE CHART TO SEE GYNECOLOGIC CANCER DRUG MONOGRAPHS.



CERVICAL CANCER TREATMENT REGIMENS

(Revised 7/2017)

© 2017 Haymarket Media, Inc.

Clinical Trials: The National Comprehensive Cancer Network recommends cancer patient participation in clinical trials as the gold standard for treatment.

Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced healthcare team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The cervical cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These cervical cancer treatment regimens are only provided to supplement the latest treatment strategies.

These Cancer Treatment Guidelines are a work in progress that may be refined as often as new significant data becomes available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The NCCN makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

Advanced Cervical Cancer1,a

NOTE: All recommendations are category 2A unless otherwise indicated.

First-line Therapyb

REGIMEN

DOSING

Cisplatin2,3

Cisplatin 40mg/m2 IV once weekly for up to 6 doses (total dose not to exceed 70mg per week).

Cisplatin + 5-FU4,5

Days 1–5 of radiotherapy: Cisplatin 75mg/m2 IV over 4 hours, followed by 5-FU 4,000mg/m2 IV over 96 hours (begin chemotherapy within 16 hours after radiotherapy).

Repeat cycle every 3 weeks for 2 additional cycles.

OR

Days 1 and 29: Cisplatin 50mg/m2 IV infusion (4 hours prior to external-beam radiotherapy) at 1mg/minute with standard hydration, plus

Days 2–5, and 30–33: 5-FU 1,000mg/m2 IV continuous infusion over 24 hours

(total dose 4,000mg/m2 each course).

Metastatic or Recurrent Cervical Cancer1,c

First-line Combination Therapyd

Cisplatin + paclitaxel + bevacizumab (Category 1)6

Day 1: Cisplatin 50mg/m2 IV + paclitaxel 135–175mg/m2 IV + bevacizumab 15mg/kg IV.

Repeat cycle every 21 days until disease progression, unacceptable toxicity, or complete response.

Paclitaxel + cisplatin

(Category 1)7,8

Day 1: Paclitaxel 135mg/m2 IV over 24 hours

Day 2: Cisplatin 50mg/m2 IV at a rate of 1mg/minute.

Repeat cycle every 3 weeks for 6 cycles.

Topotecan + paclitaxel + bevacizumab (Category 1)6

Day 1: Bevacizumuab 15mg/kg IV + Paclitaxel 175mg/m2 IV over 3 hours

Days 1–3: Topotecan 0.75mg/m2 IV over 30 minutes.

Repeat cycle every 21 days until disease progression or unacceptable toxicity.

Paclitaxel + carboplatin (Category 1 for patients with prior cisplatin therapy)9,10

Day 1: Paclitaxel 175mg/m2 IV over 3 hours, followed by 1-hour carboplatin IV at AUC 5mgmL/min.

Repeat cycle every 3 weeks for a maximum of 6 cycles or until disease progression or unacceptable toxicity.

Carboplatin + paclitaxel + bevacizumab6,10

Day 1: Paclitaxel 175mg/m2 IV over 3 hours, followed by 1-hour carboplatin IV at AUC 5mgmL/min + bevacizumab 15mg/kg IV.

Repeat cycle every 3 weeks for a maximum of 6 cycles or until disease progression or unacceptable toxicity.

Cisplatin + topotecan11

Days 1–3: Topotecan 0.75mg/m2 IV over 30 minutes, followed by

Day 1: Cisplatin 50mg/m2 IV.

Repeat cycle every 3 weeks.

Topotecan + paclitaxel6e

Days 1–3: Topotecan 0.75mg/m2 IV over 30 minutes, followed by

Day 1: Paclitaxel 175 mg/m2 IV.

Cisplatin + gemcitabine

(Category 3)12

Days 1 and 8: Cisplatin 30mg/m2 IV followed by gemcitabine 800mg/m2 IV.

Repeat cycle every 4 weeks.

Possible First-Line Single-Agent Therapy

Cisplatin (preferred as a single agent)8

Day 1: Cisplatin 50mg/m2 IV.

Repeat every 3 weeks for 6 cycles.

Carboplatin13

Day 1: Carboplatin 400mg/m2 IV.

Repeat every 4 weeks.

Paclitaxel14

Day 1: Paclitaxel 250mg/m2 IV over 3 hours.

Repeat every 3 weeks.

Second-Line Therapy

Note: Agents listed below are category 2B unless otherwise indicated.

Bevacizumab15

Day 1: Bevacizumab 15mg/kg IV.

Repeat cycle every 3 weeks until disease progression or unacceptable toxicity.

Albumin-bound paclitaxel (nab-paclitaxel)16

Days 1, 8, and 15: Nab-paclitaxel 125mg/m2 IV over 30 minutes.

Repeat cycle every 4 weeks until disease progression or unacceptable toxicity.

Docetaxel17

Day 1: Docetaxel 100mg/m2 IV over 1 hour.

Repeat cycle every 3 weeks until disease progression or unacceptable toxicity.

5-FU18

Days 1–5: Leucovorin 200mg/m2 IV bolus + 5-FU 370mg/m2 IV bolus every
4 weeks for the first 2 courses with subsequent courses given every 5 weeks.

Gemcitabine19

Days 1, 8, and 15: Gemcitabine 800mg/m2 IV over 30 minutes, with a 1-week rest until disease progression or unacceptable toxicity.

Ifosfamide20,21

Days 1–5: Ifosfamide 1.5g/m2 IV over 30 minutes; dose reduced to 1.2g/m2
in patients with prior radiotherapy.

Repeat cycle every 3 weeks.

Irinotecan22

Irinotecan 125mg/m2 IV over 90 minutes weekly for 4 weeks.

Repeat cycle every 6 weeks.

Mitomycin23

Day 1: Mitomycin 6mg/m2 IV.

Repeat cycle every 4 weeks.

Pemetrexed24

Day 1: Pemetrexed 900mg/m2 IV over 10 minutes.

Repeat cycle every 21 days.

Topotecan25,26

Days 1–5: Topotecan 1.5mg/m2 IV.

Repeat cycle every 3 to 4 weeks.

Vinorelbine27

Days 1 and 8: Vinorelbine 30mg/m2; dose omitted on day 8 for grade 3 or 4 neutropenia OR reduced to 20 mg/m2 for grade 2 neutropenia.

Repeat cycle every 3 weeks.

a Includes patients with stage 2B to 4A disease, but can be extended to include patients with 1B2 and 2A2 disease in the advanced disease category.

b Given concurrently with pelvic radiotherapy and brachytherapy; category 1 for patients without nodal disease or with disease
limited to the pelvis as determined through surgical staging. In patients with positive para-aortic and pelvic lymph nodes on
imaging studies, extraperitoneal lymph node dissection should be considered, followed by extended-field radiotherapy, concurrent cisplatin-containing chemotherapy, and brachytherapy.

c Cisplatin, carboplatin, docetaxel, and paclitaxel may cause drug reactions, which can be managed following recommendations
in NCCN Guidelines for Ovarian Cancer—Management of Drug Reaction [OV-C].

d Cost and toxicity should be carefully considered when selecting an appropriate regimen for treatment.

e Although topotecan + paclitaxel was not shown to be superior to cisplatin + paclitaxel, it may be considered an alternative
in patients who are not candidates for cisplatin.

References

1. NCCN Clinical Practice Guidelines in Oncology™. Cervical Cancer. v 1.2017. Available at: http://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed July 21, 2017.

2. Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999;340(15):1154–1161. Erratum in: N Engl J Med. 1999;341(9):708.

3. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for advanced cervical cancer. N Engl J Med. 1999;340(15):1144–1153. Erratum in: N Engl J Med. 1999;341(9):708.

4. Morris M, Eifel PF, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999;340(15):1137–1143.

5. Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol. 1999;17(5):1339–1348.

6. Tewari KS1, Sill MW, Long HJ 3rd, et al. Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med. 2014;370(8):734–743.

7. Monk BJ, Sill MW, McMeekin DS, et al. Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2009;27(28):4649–4655.

8. Moore DH, Blessing JA, McQuellon RP, et al. Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol. 2004;22(15):3113–3119.

9. Moore KN, Herzog TJ, Lewin S, et al. A comparison of cisplatin/paclitaxel and carboplatin/paclitaxel in stage IVB, recurrent or persistent cervical cancer. Gynecol Oncol. 2007;105(2):299–303.

10. Kitagawa R, Katsumata N, Shibata T, et al. Paclitaxel plus ­carboplatin versus paclitaxel plus cisplatin in metastatic or recurrent cervical cancer: the open-label randomized phase III trial JCOG0505. J Clin Oncol. 2015;33(19):2129–2135.

11. Long HJ 3rd, Bundy BN, Grendys EC Jr, et al; Gynecologic Oncology Group Study. Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group study. J Clin Oncol. 2005;23(21):4626–4633.

12. Brewer CA, Blessing JA, Nagourney RA, et al. Cisplatin plus gemcitabine in previously treated squamous cell carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2006;100(2):385–388.

13. Weiss GR, Green S, Hannigan EV, et al. A phase II trial of carboplatin for recurrent or metastatic squamous carcinoma of the uterine cervix: a Southwest Oncology Group study. Gynecol Oncol. 1990;39(3):332–336.

14. Kudelka AP, Winn R, Edwards CL, et al. An update of a phase II study of paclitaxel in advanced or recurrent squamous cell cancer of the cervix. Anticancer Drugs. 1997;8(7):657–661.

15. Monk BJ, Sill MW, Burger RA, et al. Phase II trial of beva­cizumab in the treatment of persistent or recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol. 2009;27(7):1069–1074.

16. Alberts DS, Blessing JA, Landrum LM, et al. Phase II trial of nab-paclitaxel in the treatment of recurrent or persistent advanced cervix cancer: a Gynecologic Oncology Group study. Gynecol Oncol. 2012;127(3):451–455.

17. Garcia AA, Blessing JA, Vaccarello L, et al. Phase II clinical trial of docetaxel in refractory squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Am J Clin Oncol. 2007;30(4):428–431.

18. Look KY, Blessing JA, Gallup DG, Lentz SS. A phase II trial of 5-fluorouracil and high-dose leucovorin in patients with ­recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Am J Clin Oncol. 96;19(5):439–441.

19. Schilder RJ, Blessing J, Cohn DE. Evaluation of gemcitabine in previously treated patients with non-squamous cell carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2005;96(1):103–107.

20. Coleman RE, Harper PG, Gallagher C, et al. A phase II study of ifosfamide in advanced and relapsed carcinoma of the cervix. Cancer Chemother Pharmacol. 1986;18(3):280–283.

21. Sutton GP, Blessing JA, McGuire WP, Patton T, Look KY. Phase II trial of ifosfamide and mesna in patients with advanced or recurrent squamous carcinoma of the cervix who had never received chemotherapy: a Gynecologic Oncology Group study. Am J Obstet Gynecol. 1993;168(3 Pt 1):805–807.

22. Verschraegen CF, Levy T, Kudelka AP, et al. Phase II study of irinotecan in prior chemotherapy-treated squamous cell carcinoma of the cervix. J Clin Oncol. 1997;15(2):625–631.

23. Wagenaar HC, Pecorelli S, Mangioni C, et al. Phase II study of mitomycin-C and cisplatin in disseminated, squamous cell carcinoma of the uterine cervix. A European Organization for Research and Treatment of Cancer (EORTC) Gynecological Cancer Group study. Eur J Cancer. 2001;37(13):1624–1628.

24. Miller DS, Blessing JA, Bodurka DC, Bonebrake AJ, Schorge JO; Gynecologic Oncology Group. Evaluation of pemetrexed (Alimta, LY231514) as second line chemotherapy in persistent or recurrent carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2008;110(1):65–70.

25. Bookman MA, Blessing JA, Hanjani P, Herzog TJ, Andersen WA. Topotecan in squamous cell carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2000;77(3):446–449.

26. Muderspach LI, Blessing JA, Levenback C, Moore JL Jr. A phase II study of topotecan in patients with squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 2001;81(2):213–215.

27. Muggia FM, Blessing JA, Method M, et al; Gynecologic Oncology Group study. Evaluation of vinorelbine in persistent or recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92(2):639–643.


Gynecological Cancer Drug Monographs

Gynecologic Cancers

ALKERAN AVASTIN Bleomycin
Carboplatin Cisplatin COSMEGEN
Cyclophosphamide CYTOXAN INJECTION DEPO-PROVERA
DOXIL Doxorubicin HCl Doxorubicin HCl Solution
GEMZAR HEXALEN HYCAMTIN
LYNPARZA Megestrol acetate Methotrexate for injection
Methotrexate injection RUBRACA TAXOL
Thiotepa TREXALL Vinblastine for injection
Vinblastine injection ZEJULA

Data provided by the Monthly Prescribing Reference (MPR) Hematology/Oncology Edition.
————— BACKUP
SEE BELOW THE CHART TO SEE GYNECOLOGIC CANCER DRUG MONOGRAPHS.



CERVICAL CANCER TREATMENT REGIMENS

(Revised 7/2017)

© 2017 Haymarket Media, Inc.

Clinical Trials: The National Comprehensive Cancer Network recommends cancer patient participation in clinical trials as the gold standard for treatment.

Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced healthcare team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The cervical cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These cervical cancer treatment regimens are only provided to supplement the latest treatment strategies.

These Cancer Treatment Guidelines are a work in progress that may be refined as often as new significant data becomes available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The NCCN makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

Advanced Cervical Cancer1,a

NOTE: All recommendations are category 2A unless otherwise indicated.

First-line Therapyb

REGIMEN

DOSING

Cisplatin2,3

Cisplatin 40mg/m2 IV once weekly for up to 6 doses (total dose not to exceed 70mg per week).

Cisplatin + 5-FU4,5

Days 1–5 of radiotherapy: Cisplatin 75mg/m2 IV over 4 hours, followed by 5-FU 4,000mg/m2 IV over 96 hours (begin chemotherapy within 16 hours after radiotherapy).

Repeat cycle every 3 weeks for 2 additional cycles.

OR

Days 1 and 29: Cisplatin 50mg/m2 IV infusion (4 hours prior to external-beam radiotherapy) at 1mg/minute with standard hydration, plus

Days 2–5, and 30–33: 5-FU 1,000mg/m2 IV continuous infusion over 24 hours

(total dose 4,000mg/m2 each course).

Metastatic or Recurrent Cervical Cancer1,c

First-line Combination Therapyd

Cisplatin + paclitaxel + bevacizumab (Category 1)6

Day 1: Cisplatin 50mg/m2 IV + paclitaxel 135–175mg/m2 IV + bevacizumab 15mg/kg IV.

Repeat cycle every 21 days until disease progression, unacceptable toxicity, or complete response.

Paclitaxel + cisplatin

(Category 1)7,8

Day 1: Paclitaxel 135mg/m2 IV over 24 hours

Day 2: Cisplatin 50mg/m2 IV at a rate of 1mg/minute.

Repeat cycle every 3 weeks for 6 cycles.

Topotecan + paclitaxel + bevacizumab (Category 1)6

Day 1: Paclitaxel 175mg/m2 IV over 3 hours, followed by 1-hour carboplatin IV at AUC 5mgmL/min.

Repeat cycle every 3 weeks for a maximum of 6 cycles or until disease progression or unacceptable toxicity.

Paclitaxel + carboplatin (Category 1 for patients with prior cisplatin therapy)9,10

Day 1: Paclitaxel 175mg/m2 IV over 3 hours, followed by 1-hour carboplatin IV at AUC 5mgmL/min.

Repeat cycle every 3 weeks for a maximum of 6 cycles or until disease progression or unacceptable toxicity.

Carboplatin + paclitaxel + bevacizumab6,10

Day 1: Paclitaxel 175mg/m2 IV over 3 hours, followed by 1-hour carboplatin IV at AUC 5mgmL/min + bevacizumab 15mg/kg IV.

Repeat cycle every 3 weeks for a maximum of 6 cycles or until disease progression or unacceptable toxicity.

Cisplatin + topotecan11

Days 1–3: Topotecan 0.75mg/m2 IV over 30 minutes, followed by

Day 1: Cisplatin 50mg/m2 IV.

Repeat cycle every 3 weeks.

Topotecan + paclitaxel6e

Days 1–3: Topotecan 0.75mg/m2 IV over 30 minutes, followed by

Day 1: Paclitaxel 175 mg/m2 IV.

Cisplatin + gemcitabine

(Category 3)12

Days 1 and 8: Cisplatin 30mg/m2 IV followed by gemcitabine 800mg/m2 IV.

Repeat cycle every 4 weeks.

Possible First-Line Single-Agent Therapy

Cisplatin (preferred as a single agent)8

Day 1: Cisplatin 50mg/m2 IV.

Repeat every 3 weeks for 6 cycles.

Carboplatin13

Day 1: Carboplatin 400mg/m2 IV.

Repeat every 4 weeks.

Paclitaxel14

Day 1: Paclitaxel 250mg/m2 IV over 3 hours.

Repeat every 3 weeks.

Second-Line Therapy

Note: Agents listed below are category 2B unless otherwise indicated.

Bevacizumab15

Day 1: Bevacizumab 15mg/kg IV.

Repeat cycle every 3 weeks until disease progression or unacceptable toxicity.

Albumin-bound paclitaxel (nab-paclitaxel)16

Days 1, 8, and 15: Nab-paclitaxel 125mg/m2 IV over 30 minutes.

Repeat cycle every 4 weeks until disease progression or unacceptable toxicity.

Docetaxel17

Day 1: Docetaxel 100mg/m2 IV over 1 hour.

Repeat cycle every 3 weeks until disease progression or unacceptable toxicity.

5-FU18

Days 1–5: Leucovorin 200mg/m2 IV bolus + 5-FU 370mg/m2 IV bolus every
4 weeks for the first 2 courses with subsequent courses given every 5 weeks.

Gemcitabine19

Days 1, 8, and 15: Gemcitabine 800mg/m2 IV over 30 minutes, with a 1-week rest until disease progression or unacceptable toxicity.

Ifosfamide20,21

Days 1–5: Ifosfamide 1.5g/m2 IV over 30 minutes; dose reduced to 1.2g/m2
in patients with prior radiotherapy.

Repeat cycle every 3 weeks.

Irinotecan22

Irinotecan 125mg/m2 IV over 90 minutes weekly for 4 weeks.

Repeat cycle every 6 weeks.

Mitomycin23

Day 1: Mitomycin 6mg/m2 IV.

Repeat cycle every 4 weeks.

Pemetrexed24

Day 1: Pemetrexed 900mg/m2 IV over 10 minutes.

Repeat cycle every 21 days.

Topotecan25,26

Days 1–5: Topotecan 1.5mg/m2 IV.

Repeat cycle every 3 to 4 weeks.

Vinorelbine27

Days 1 and 8: Vinorelbine 30mg/m2; dose omitted on day 8 for grade 3 or 4 neutropenia OR reduced to 20 mg/m2 for grade 2 neutropenia.

Repeat cycle every 3 weeks.

a Includes patients with stage 2B to 4A disease, but can be extended to include patients with 1B2 and 2A2 disease in the advanced disease category.

b Given concurrently with pelvic radiotherapy and brachytherapy; category 1 for patients without nodal disease or with disease
limited to the pelvis as determined through surgical staging. In patients with positive para-aortic and pelvic lymph nodes on
imaging studies, extraperitoneal lymph node dissection should be considered, followed by extended-field radiotherapy, concurrent cisplatin-containing chemotherapy, and brachytherapy.

c Cisplatin, carboplatin, docetaxel, and paclitaxel may cause drug reactions, which can be managed following recommendations
in NCCN Guidelines for Ovarian Cancer—Management of Drug Reaction [OV-C].

d Cost and toxicity should be carefully considered when selecting an appropriate regimen for treatment.

e Although topotecan + paclitaxel was not shown to be superior to cisplatin + paclitaxel, it may be considered an alternative
in patients who are not candidates for cisplatin.

References

1. NCCN Clinical Practice Guidelines in Oncology™. Cervical Cancer. v 1.2017. Available at: http://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed July 21, 2017.

2. Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999;340(15):1154–1161. Erratum in: N Engl J Med. 1999;341(9):708.

3. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for advanced cervical cancer. N Engl J Med. 1999;340(15):1144–1153. Erratum in: N Engl J Med. 1999;341(9):708.

4. Morris M, Eifel PF, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999;340(15):1137–1143.

5. Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol. 1999;17(5):1339–1348.

6. Tewari KS1, Sill MW, Long HJ 3rd, et al. Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med. 2014;370(8):734–743.

7. Monk BJ, Sill MW, McMeekin DS, et al. Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2009;27(28):4649–4655.

8. Moore DH, Blessing JA, McQuellon RP, et al. Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol. 2004;22(15):3113–3119.

9. Moore KN, Herzog TJ, Lewin S, et al. A comparison of cisplatin/paclitaxel and carboplatin/paclitaxel in stage IVB, recurrent or persistent cervical cancer. Gynecol Oncol. 2007;105(2):299–303.

10. Kitagawa R, Katsumata N, Shibata T, et al. Paclitaxel plus ­carboplatin versus paclitaxel plus cisplatin in metastatic or recurrent cervical cancer: the open-label randomized phase III trial JCOG0505. J Clin Oncol. 2015;33(19):2129–2135.

11. Long HJ 3rd, Bundy BN, Grendys EC Jr, et al; Gynecologic Oncology Group Study. Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group study. J Clin Oncol. 2005;23(21):4626–4633.

12. Brewer CA, Blessing JA, Nagourney RA, et al. Cisplatin plus gemcitabine in previously treated squamous cell carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2006;100(2):385–388.

13. Weiss GR, Green S, Hannigan EV, et al. A phase II trial of carboplatin for recurrent or metastatic squamous carcinoma of the uterine cervix: a Southwest Oncology Group study. Gynecol Oncol. 1990;39(3):332–336.

14. Kudelka AP, Winn R, Edwards CL, et al. An update of a phase II study of paclitaxel in advanced or recurrent squamous cell cancer of the cervix. Anticancer Drugs. 1997;8(7):657–661.

15. Monk BJ, Sill MW, Burger RA, et al. Phase II trial of beva­cizumab in the treatment of persistent or recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol. 2009;27(7):1069–1074.

16. Alberts DS, Blessing JA, Landrum LM, et al. Phase II trial of nab-paclitaxel in the treatment of recurrent or persistent advanced cervix cancer: a Gynecologic Oncology Group study. Gynecol Oncol. 2012;127(3):451–455.

17. Garcia AA, Blessing JA, Vaccarello L, et al. Phase II clinical trial of docetaxel in refractory squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Am J Clin Oncol. 2007;30(4):428–431.

18. Look KY, Blessing JA, Gallup DG, Lentz SS. A phase II trial of 5-fluorouracil and high-dose leucovorin in patients with ­recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Am J Clin Oncol. 96;19(5):439–441.

19. Schilder RJ, Blessing J, Cohn DE. Evaluation of gemcitabine in previously treated patients with non-squamous cell carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2005;96(1):103–107.

20. Coleman RE, Harper PG, Gallagher C, et al. A phase II study of ifosfamide in advanced and relapsed carcinoma of the cervix. Cancer Chemother Pharmacol. 1986;18(3):280–283.

21. Sutton GP, Blessing JA, McGuire WP, Patton T, Look KY. Phase II trial of ifosfamide and mesna in patients with advanced or recurrent squamous carcinoma of the cervix who had never received chemotherapy: a Gynecologic Oncology Group study. Am J Obstet Gynecol. 1993;168(3 Pt 1):805–807.

22. Verschraegen CF, Levy T, Kudelka AP, et al. Phase II study of irinotecan in prior chemotherapy-treated squamous cell carcinoma of the cervix. J Clin Oncol. 1997;15(2):625–631.

23. Wagenaar HC, Pecorelli S, Mangioni C, et al. Phase II study of mitomycin-C and cisplatin in disseminated, squamous cell carcinoma of the uterine cervix. A European Organization for Research and Treatment of Cancer (EORTC) Gynecological Cancer Group study. Eur J Cancer. 2001;37(13):1624–1628.

24. Miller DS, Blessing JA, Bodurka DC, Bonebrake AJ, Schorge JO; Gynecologic Oncology Group. Evaluation of pemetrexed (Alimta, LY231514) as second line chemotherapy in persistent or recurrent carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2008;110(1):65–70.

25. Bookman MA, Blessing JA, Hanjani P, Herzog TJ, Andersen WA. Topotecan in squamous cell carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2000;77(3):446–449.

26. Muderspach LI, Blessing JA, Levenback C, Moore JL Jr. A phase II study of topotecan in patients with squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 2001;81(2):213–215.

27. Muggia FM, Blessing JA, Method M, et al; Gynecologic Oncology Group study. Evaluation of vinorelbine in persistent or recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92(2):639–643.


Gynecological Cancer Drug Monographs

Gynecologic Cancers

ALKERAN AVASTIN Bleomycin
Carboplatin Cisplatin COSMEGEN
Cyclophosphamide CYTOXAN INJECTION DEPO-PROVERA
DOXIL Doxorubicin HCl Doxorubicin HCl Solution
GEMZAR HEXALEN HYCAMTIN
LYNPARZA Megestrol acetate Methotrexate for injection
Methotrexate injection RUBRACA TAXOL
Thiotepa TREXALL Vinblastine for injection
Vinblastine injection ZEJULA

Data provided by the Monthly Prescribing Reference (MPR) Hematology/Oncology Edition.

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